A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. A 55-year-old Mississippi man with severe hypertension and kidney disease is repeatedly hospitalized for worsening heart and kidney failure; doctors don't know that his utilities have been disconnected, leaving him without air conditioning or a refrigerator in the sweltering summer heat. A 42-year-old morbidly obese woman with severe cardiovascular problems and bipolar disorder spends more than 300 days in a Michigan hospital and nursing home because she can't afford a special bed or arrange services that would enable her to live at home. These patients are among the 1 percent whose ranks no one wants to join, says Kaiser Health News.

• The costly 1 percent battling multiple chronic illnesses consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person.
• Five percent of patients accounted for 50 percent of all health care expenditures.
• By contrast, the bottom 50 percent of patients accounted for just 2.8 percent of spending.

The problem is receiving increasingly urgent attention from hospitals and insurance companies, which are facing pressure to deliver better and more cost-effective care. The Affordable Care Act is ramping up penalties levied on hospitals for certain Medicare patients readmitted within 30 days of discharge.

Hospitals have traditionally made more money readmitting patients than trying to prevent them from bouncing back.

Insurers are also scrambling. They are expected to enroll millions of new customers under the new health care law but can no longer control costs by imposing lifetime expenditure caps or refusing to cover preexisting conditions.

Source: Sandra G. Boodman, "Costliest 1 Percent of Patients Account for 21 Percent of U.S. Health Spending," Kaiser Health News, October 7, 2013.

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